Measles: Catching Your Death—A Public Health Crisis

Source: Monkey Business Images / Adobe Stock

By Ava Easton, Ph.D.

I know about measles. I had it as a child and was pretty unwell with it, confined to a darkened room for more than a week with concerns raised for my eyesight, among other things. Decades later, I still know about measles because I work with patients who have encephalitis because of it, and also families left bereaved by it. It is not the innocuous childhood illness that many would have you believe. It is serious and deadly. Measles kills. It’s that simple.

Roald Dahl knew about measles, too (from his 1986 letter to parents; Encephalitis International):

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

“Are you feeling all right?” I asked her.

“I feel all sleepy,” she said.

In an hour, she was unconscious.

In twelve hours she was dead.

The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.

What is measles?

Measles is a highly infectious viral illness. It can be very unpleasant to endure, even without experiencing any serious complications. Anyone can get measles if they haven't been vaccinated or haven't had it before.

Initial symptoms occur around 10 days after infection and include cold-like symptoms, sensitivity to light, sore red eyes, and fever. A few days later, a reddish-brown rash will appear across the body.

Most people will recover from measles a week or two after they first become ill; however, it can lead to serious complications, including life-changing disabilities and death. Measles can be prevented by having the MMR (measles, mumps, and rubella) vaccination.

• Ninety percent of unvaccinated people exposed to measles will become infected.
• A single person with measles will be able to infect nine other people who are not immune.
• Between one and three people in every 1,000 who catch measles will die.

A once near-eradicated disease is again a public health crisis.

Worldwide, measles is still a major cause of death, especially among children in resource-poor countries. Over the last two decades, however, vaccination has dramatically reduced the number of deaths from measles.

In 1990, measles killed 872,000 people worldwide, and by 2016 it was estimated that about 90,000 people died of measles. Globally, now, however, there has been an 18 percent increase in estimated measles cases according to a joint report published in November 2023 from the World Health Organization (WHO) and the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC; Minta et al., 2023; WHO, 2023). They also found a significant increase in measles deaths, estimating an increase of 43 percent during 2021–2022, from 95,000 to 136,200 (260-373 people dying every day). The report found that between 2000 and 2022, measles vaccination prevented close to 57 million deaths worldwide. However, millions of children missed vaccinations during the COVID-19 pandemic, resulting in the lowest coverage of those receiving their first dose of measles vaccination since 2008.

Low-income countries, where the risk of death from measles is highest, continue to have the lowest vaccination rates at only 66 percent.

How did we let this happen?

According to UNICEF (2024), the current grim global vaccination picture results from a mixture of complacency, misinformation, scepticism about immunisations, and a lack of access to vaccination.

Whilst fear of vaccines is not new (opposition can be traced as far back as the 18th century), a significant catalyst for the current vaccine-hesitancy and the more mobilised anti-vaccine movement was the publication of a paper by disgraced doctor Andrew Wakefield in 1998. In the bad science of the paper (he had undisclosed conflicts of interest and his research methods were unethical) he asserted that, in a study of only 12 children, the MMR vaccine was responsible for autism-like behaviours. In 2010, more than a decade after its publication, and in large part thanks to a reporter named Brian Deer, The Lancet finally and fully retracted the paper. Wakefield was also struck off as a practicing doctor by the General Medical Council.

As a result, a public health scare around the vaccine ensued, and it is this that fed much of the vaccine-hesitancy and anti-vaccination movement we see today. Further misleading papers and theories emerged suggesting further vaccine-autism links such as mercury poisoning related to a preservative found in some vaccines, aluminum poisoning, and "antigenic overload" (the need to spread out vaccines to overload children’s immune systems).

Of course, we must recognise that some people exercise their autonomy and legitimately oppose vaccines due to their personal or religious beliefs. If vaccination rates provide a herd immunity to diseases like measles, then this means that wider society can accommodate these genuine personal choices.

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Why are the viewpoints of the vaccine hesitancy and anti-vax movements not as legitimate and genuine as people who choose not to vaccinate due to their personal or religious beliefs? Simply because, as Hussain et al. (2018) remind us:

Online anti-vaccination authors…tactics include…skewing science, shifting hypotheses, censoring opposition, attacking critics, claiming to be ‘pro-safe vaccines’ and not ‘anti-vaccine’, claiming that vaccines are toxic or unnatural, and more. Not only are these tactics deceitful and dishonest, they are also very effective on many parents.

The growth of technology and our capacity to share our views and stories digitally is a positive thing for people. It can reduce isolation and loneliness as well as help educate and inform us about things we otherwise might remain inexperienced about. However, this also means that information about medicines and disease has shifted from being the province of the medical practitioner to being accessible to the layperson. The flip side of this is that the creation and distribution of fictitious, fake, and false information is possible.

One caveat I will make is that some of the proponents of vaccine misinformation affect some of the most vulnerable: Parents who have lost children or whose children have life-changing disabilities are led to believe vaccination was the cause. I have seen and heard from these parents—their loss and distress is palpable and heart-breaking. Along with patients and families affected by the complications of measles, these parents are also victims of erroneous and misguided information.

What needs to be done to address this preventable crisis?

Our health systems are already overburdened and at a breaking point. Outbreaks of preventable diseases like measles only serve to increase that strain.

We must make vaccination as accessible as possible and meet head-on vaccine misinformation by overwhelming and overpowering it with the truth: that vaccines save millions of lives around the world each year.

With thanks to Emma Collins, Encephalitis International, for support with this post.